Debate: what is the best method to monitor surgical performance?
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Date
2016-04-05
Authors
Woodall, William
Steiner, Stefan H.
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Background
There is considerable recent interest in the monitoring of individual surgeon or hospital surgical outcomes. If one aggregates data over time and assesses performance with a funnel plot, then the detection of any process deterioration or improvement could be delayed. The variable life adjusted display (VLAD) is widely used for monitoring on a case-by-case basis, but we show that use of the risk-adjusted Bernoulli cumulative sum (RA-CUSUM) chart leads to much better performance.
Discussion
We use simulation to illustrate that the RA-CUSUM chart has better performance than the VLAD in detecting changes in the rates of adverse events.
Summary
We recommend the RA-CUSUM approach over the VLAD approach for monitoring surgical performance. If the VLAD is used, we recommend running the RA-CUSUM chart in the background to generate signals that the process performance has changed.
Description
Keywords
Debate, Surgical outcomes, Monitoring, Variable life adjusted display (VLAD), Risk-adjusted Bernoulli cumulative sum (RA-CUSUM)